Public Health Congress 2018: Exploring the patient journey in weight loss: A social network analysis - Lynn Cheong - University of Canberra



 Background Long-term weight management consists of weight-loss, weight-loss maintenance, and weight-gain stages. Qualitative insights into weight management are now appearing in the literature however research appears to be biased towards explorations of weight-loss maintenance. The qualitative understanding of weight loss, which begets weight-loss maintenance and might establish the experiences and behaviours necessary for successful long-term weight management, is comparatively under-investigated. The aim of this study was to investigate the weight-loss experiences of a sample of participants not aligned to clinical intervention research, in order to understand the weight-loss experiences of a naturalistic sample. Methods Participants (n = 8) with weight-loss (n = 4) and weight-maintenance experiences (n = 4) were interviewed using a semi-structured interview to understand the weight-loss experience. Interview data was analysed thematically using Framework Analysis and was underpinned by realist meta-theory. Results Weight loss was experienced as an enduring challenge, where factors that assisted weight loss were developed and experienced dichotomously to factors that hindered it. Participants described barriers to (dichotomous thinking, environments, social pressures and weight centeredness) and facilitators of (mindfulness, knowledge, exercise, readiness to change, structure, self-monitoring and social support) their weight-loss goals in rich detail, highlighting that weight loss was a complex experience. Background Weight loss is a complex problem, where physical, environmental, and behavioural factors disrupt and assist dieters in their pursuit of negative energy balance [1]. Evidence indicates that weight loss leads to adaptations that increase appetite [2], the desire to eat and preoccupations with food, cravings, and reduced energy cost of activity. Weight-loss is therefore multifaceted, and often difficult to achieve, explaining why over 80 % of dieters regain lost weight. Small proportions of individuals do achieve and maintain weight loss however, and research has sought to identify factors that differentiate these individuals from those who are unable to achieve their weight-loss goals  Successful dieters modify their lifestyles to achieve early successes ; they maintain and remodel their newfound behaviours over time; they possess social support mechanisms, and are attentive to threats to their weight status. Importantly, successful dieters view weight loss as a lifelong commitment. Despite a growing body of evidence that unpicks factors associated with successful weight management , much of the literature has been undertaken using quantitative methods, which might not fully reveal the complexity of the experience. The qualitative study of weight management appears to be in its infancy and deep insights into the weight-management journey have begun to appear in the literature . Much of this research has been conducted using samples obtained from weight-management intervention studies, often in an attempt to explore weight-loss maintenance, and as a result much less is known about the weight-loss phase of the weight-management journey, particularly the experiences of individuals who accommodate weight-loss without the focus of research-based interventions. The aim of this study was to explore the weight-loss experiences of dieters not aligned to research, to provide a rich, detailed account of how these people experienced and accommodated their weight loss efforts, in real-life contexts. Methods Theoretical underpinning This study was underpinned by realist meta-theory, which enables and requires the deep exploration and description of participants’ perspectives, experiences and realities in an objective and explicit matter. Ethical approval for this research was granted by Sheffield Hallam University’s research degrees ethics committee. Sampling Participants were included using purposive sampling, and data saturation was used as a guiding principal for sample size, which was determined iteratively. Adverts for participants who had experiences of undertaking a weight-loss diet were placed in local slimming clubs, health clubs and gyms, the employee intranet and email lists at Sheffield Hallam University, and by networking with colleagues. Participants were recruited into the study until data saturation was achieved, which was defined at the point where no new themes emerged from the transcripts. To achieve this, each participant was interviewed and recorded. Recordings were then transcribed and analysed upon receipt, and further participants were recruited to the study up until no new themes emerged from the analyses. Guest and colleagues demonstrated that samples as few as 6 participants were sufficient to achieve data saturation in their investigation to determine non-probabilistic sample size requirements. A sample of 6 participants was therefore expected to be the minimum sampling requirement to achieve data saturation in this research. Data collection Interview data was collected face to face and prompted by an interview guide that was developed from the extant literature. All interviews were recorded using a portable digital recording device (Olympus Digital Voice Recorder, model WS-321 M, Olympus Imaging Corp, China) and were conducted in a neutral, quiet environment that was mutually agreed upon prior to data collection. Interviews were supplemented with field notes, and lasted approximately 60–75 min. Respondent validation was sought from each participant after their interviews to ensure credibility, and to ensure that the interviews had provided them with sufficient opportunity to articulate their experiences . Upon completion of the interviews the audio files were saved to a password-protected external hard drive (WD My Passport, Western Digital, Irvine, California, USA), under the prefix of participant 1, participant 2, etc., to ensure participant confidentiality and anonymity. All interviews were transcribed verbatim by a data transcription service. Conclusions Weight loss was a difficult task, with physical, social, behavioural and environmental elements that appeared to assist and inhibit weight-loss efforts concurrently. Health professionals might need to better understand the day-to-day challenges of dieters in order to provide more effective, tailored treatments. Future research should look to investigate the psycho-social consequences of weight-loss dieting, in particular self-imposed social exclusion and spousal sabotage and flexible approaches to treatment. Biography Lynn Cheong is a Clinical Assistant Professor of Pharmacy at the University of Canberra in Australia. She is a Registered Pharmacist with a wide array of experience in hospital and community pharmacy, as well as government and education. She continues to remain professionally active and strives to advance the role of pharmacists in improving patient and health system outcomes. Her research interest is in the application of social network analysis theories and techniques in health service research. Her research lies in the areas of patient-centered care, quality use of medicines, interprofessional education and practice. [email protected]

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